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Another VA Medical related question to those in the know....

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Posted 12/29/2013 5:27 AM (GMT 0)
I was in the USN, myself, AC3 from 61 t0 64 under the kitty cruise program. Witnessed a P2V, 2 turning and 2 burning Neptune { predecessor to the Orion} from VP 17 go straight into a mountain after aborting a landing in Kodiak, AK, killing 9 out of 12 instantly. 3 survived from the tail section that split off, but were badly burned. Nasty orientation into the world of ATC for a 20 y/o. I loved the navy, midrats the the chocolate cow that never went dry, surf on a shingle, I meant stuff, but won't argue spellcheck on its word. Have never had closer friends , anytime before or after that time. It was glorious,and provided me with a career. Anyone interested in my description of that crash google VP17 crash Kodiak 1962. A nice memorial there also for those who perished in VP squadrons.
Posted 12/29/2013 5:34 AM (GMT 0)
Small absurd ditties, like what we read or write and what we put our personal items in tied, to our bunk. the Dittybag. Better be still hanging after barracks inspection or off to the hanger to push the piece for an hour.
Posted 12/29/2013 5:37 AM (GMT 0)
logo - I was proudly serving in VP-17, but when I was in, we were all P-3's, the Neptunes had been phased out. Was familiar with the crash you spoke about. We lost one plane in combat, and another in a mysterious explosion over Nevada, killing all the crew

Jim - I was remember another Navy bud of mine. We went into boot together in FL, graduated the same time from the same high school, they had a "buddy" program back then. He wanted Nam, got Nam right out of boot. He was literally killed his first day in country in Cam Rah Bay. He had just gotten to the incoming barracks, when a stray mortar shell made a direct hit. He was killed instantly, along with 2-3 others. It was almost like a death wish thing with him. I will never forget that. We graduated from boot at Orlando, Company 119, we were the brigage company, and won every possible flag that could be won. He was a great guy and a great friend at the time. 18 was too young to die that way.

David
Posted 12/29/2013 6:22 AM (GMT 0)
Logo,

After I left the navy in '71 my squadron, VP-8, moved to Brunswick Maine. A year or two later one of our P3A's flew into a mountain side in the fog with no survivors. When I was in Nam (before I was in VP-8) about half of the patrol squadrons that rotated through were still flying P2 Neptunes. In fact I spent a night at Task Force 115 (MarketTime) headquarters in Cam Ranh Bay and was supposed to take a familiarization flight on a P2, but as luck had it there was a spare seat on our Task Force's C-47 that would get me north to Danang where I was needed as a replacement. So I was put on that plane and missed my P2 patrol. I also didn't get to do a swift boat patrol until after I was in Danang.

Purg,

Don't know when your buddy was in Cam Ranh Bay. This would have been a couple of years after I passed through there. But I was in Danang during Tet Offensive in '68. Cam Ranh Bay was our command (we were a small detachment of 25 men in Danang who reported directly to CTF 115 at Cam Ranh Bay). As I recall Cam Ranh Bay took a major ammo dump hit during Tet '68, and I'm sure they remained a favored target thereafter.
Posted 12/29/2013 6:30 AM (GMT 0)
 

David,

You asked an honest question and got honest answers. Nothing negative that I read except the flame-thrower post that got yanked as soon as a moderator read it. As you know, there are lots of different strong opinions on this forum, and if you're not willing to hear opinions you don't agree with, then maybe you shouldn't ask the question. I know that you've had an excruciatingly painful medical journey the past 5 years, and everyone here knows and appreciates that and supports you.

Post Edited (Tim G) : 12/28/2013 11:34:43 PM (GMT-7)

Posted 12/29/2013 2:17 PM (GMT 0)
David, I thought you mentioned that since ssd, you have not paid any out of pocket expenses? 
Posted 12/29/2013 2:47 PM (GMT 0)

gunfighter said...
Bohemond(Jim) and Purg(Dave),
I just received my January edition of "The American Legion Magazine" and a
lengthy article deals with Agent Orange and the Navy; some of the story's are
Beyond belief. Recommend any Navy men get the magazine!!
I was probably the only Army man in 11 corps to wear a light marine corps flak jacket. I was "snookered" by a Marine Lt that told me the plates were kelvar; I found out they were only plastic 10 years ago--lol.
So who was the dumb a-- in that barter ?
Bill idea

Bill, thanks for the heads up on the magazine. I just found the article online.

www.legion.org/magazine/218114/find-my-favor

Jim
Posted 12/29/2013 3:00 PM (GMT 0)
Tim,

When a person is asking a very specific technical question like I asked, that's what I expect for answers. Some of the earlier post were trying to question my motivation for seeking what I was seeking.

I don't care if people disagree about my opinion, and I take all reasonable answers to any post in the spirit that they were written in. However, there were some people saying things, that had absolutely nothing to do with my question, instead, they were making commentary about what I was asking.

That's two different cups of tea.

David

Once I was approved by the VA, simply trying to understand the scope and breadth of what I am entitled to in the way of benefits. The VA doesn't always make this clear or easy to understand, and some of it depends on the state one lives in.
Posted 12/29/2013 3:03 PM (GMT 0)
montee, that's generaly true about out of pocket expenses since my SSD, concerning seeing doctors. I still pay lots of money out of pocket for meds and Ostomy supplies. Some months, toward the end of a year, I am paying almost 500 a month for meds, despite having a medicare drug supplemental, and the Ostomy supplies run close to 300 a month. Those two alone, talking 800 a month.

For whatever reason, my oncologist never charges me any difference to whatever Medicare is paying him.

David
Posted 12/29/2013 3:38 PM (GMT 0)
Those out of pocket add up David and that is why I now get most my meds from the VA as there is no co-pay. They will bill your insurance but you do not pay out of pocket. The only one I cant get does not have a generic yet, but it is due out this coming year.
Michael
Posted 12/29/2013 3:43 PM (GMT 0)
thanks Michael, I am hoping that will be the case with my more expensive meds. There are times in the year that I am paying almost 400 a month, for my Fentanyl patches, and that's at the generic price, if not generic, they range from 700-1100 per month.

david
Posted 12/29/2013 3:44 PM (GMT 0)
I think Purgatory has a penchant for hyperbole in his posts. Once I realized this I just mentally shuck it out of his posts and try to understand em. He used a very wide brush in the criticism of others posts.As I said before I personally only saw one negative and that got settled. Most of us are not going to change much, so Im trying to adapt to each persons " negatives ". At some point we will get to a point where we say to ourselves, Oh, thats just Purgatory or Logo or whosit and go on about our business. But admittedly at times we all should call out and/or be called out. When that happens, we all get it, regardless of the ouches.
Posted 12/29/2013 3:45 PM (GMT 0)

Purgatory said...
Tim,

When a person is asking a very specific technical question like I asked, that's what I expect for answers. Some of the earlier post were trying to question my motivation for seeking what I was seeking.

I don't care if people disagree about my opinion, and I take all reasonable answers to any post in the spirit that they were written in. However, there were some people saying things, that had absolutely nothing to do with my question, instead, they were making commentary about what I was asking.

That's two different cups of tea.

David

Once I was approved by the VA, simply trying to understand the scope and breadth of what I am entitled to in the way of benefits. The VA doesn't always make this clear or easy to understand, and some of it depends on the state one lives in.

I still think you're mistaken about the negative comments.  I think that everyone, with the exception I noted earlier, answered your questions, directly or indirectly. And I asked two clarifying questions, which you didn't answer.  In direct answer to your second question: No I don't have any experience with this sort of thing.  I will leave your first question about your logic for you to answer, because I have no answer that will satisfactorily answer that.

Posted 12/29/2013 3:56 PM (GMT 0)
posted 3/6/2012

I have been on Medicare as my primary since July of last year, couldnt be happier (as the result of getting put on SSD). They are covering much better than when my wife's BCBS was the primary. Medicare pays for 100% of my re-hab - no copays, 100% of my urostomy supplies (which run $300 a month), since I made the swtich, my oncologist's office has never billed me for a dime. I am using the AARP version of the Medicare drug plan, and has greatly reduced my monthly prescription costs. Right now, I have nothing to complain about. None of my doctors have seemed to mind the switch to Medicare for me.

david
Age: 59, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, original catheters 63 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81, 6/11 5.8, 12/11 14.0
Other: Spent total of 1 ½ years on 21 catheters, had Ileal Conduit Surgery 9/10
Member of Prostate Cancer & Chronic Pain HW Communities
Posted 12/29/2013 4:26 PM (GMT 0)
The medication list from the base pharmacy (not a VA center) where we get my mom's meds seems to change a lot, and things she has taken for years vanish overnight, replaced with supposedly, but not always equivalent drugs (per her experience and her doctor's evaluations).

We've learned that what you can get is only as good as what they offer this month. She has to go to regular or mail order pharmacies for a lot of things, and pays a significant co-pay (as much or more than I pay in my private insurance).

The coverage is valuable, but not even close to perfect.

I made the tax comment based on the experience of a vet co-worker who got a big chunk of back costs paid after some years of effort. Problem was, the way it was paid, it became pure income at the highest tax rate, and punched him into a much higher income category. He lost most of it to taxes and accountant fees as they tried to average his income and redo past year's returns to make some headway. His final opinion was that winning isn't everything. He figures a new Glock and some ammo was his net reward.
Posted 12/29/2013 5:22 PM (GMT 0)
On the fence,
You have the right to be indignant, but simply have the wrong target. The guys that are plugging up the VA system are the ones with chronic age related claims like hearing issues and back issues. The VA rep visiting our club said he could get anyone a 10% rating because of hearing loss. My friend's SIL served as a REMF in Bosnia and got a PTSD claim approved. My friend kicked him out of his house because he kew it was a fraud. There are always those who will try to take advantage of the system. Our culture has changed, few of the WWII vets ever filed a claim unless they were really injured. In today's world you have different values.
Posted 12/29/2013 5:38 PM (GMT 0)
I agree John....too many people out there today think theyre entitled....which is why this countries going broke. Ive seen many people abuse VA and many of them were not service connected. It seems the VA will treat anybody...service connected or not.

I hear these stories of men missing limbs from Iraq and yet they have to wait long periods of time for an appointment.....I know a guy that was kicked out of the Army after serving 2 years of a 4 year enlistment...he was chaptered out for drug use and dealing....yet at the age of 50 he needed a new liver because of heavy drinking all his life and using needles back in his shooting up days.....well the VA is treating him and he doesn't pay a dime.....The VA needs to be totally revamped in my opinion.
Posted 12/29/2013 5:43 PM (GMT 0)
This is an invitation to watch the line of David's post vs. how we might think the VA is or should be run (I have my own opinions as well).
Posted 12/29/2013 6:27 PM (GMT 0)
David, I'm not clear on how you figure your medical expenses. Isn't Medicare paying for all your ostomy supplies? I imagine there's quite a bit of out-of-pocket for the pain meds especially once you hit the donut hole in Medicare so these may be worth pursuing. As for the bladder by-pass surgery, you should sit down and figure out what out of pocket expenses you incurred for this...the hospital statement and/or statement from the insurance company should provide you with a good starting part. When John had his prostatectomy, we had to pay $250 upfront...that was it, no other charges were billed to us by the hospital, the surgeon, or the anesthesiologist. I imagine the cost of your by-pass surgery worked in a similar manner...you had an upfront cost, and then everything was pretty much covered.

Only you can decide if what you paid out of pocket while your VA claim was being investigated is worth going to the VA for. But it's probably worth asking the question when you meet with your VA representative.
Posted 12/29/2013 8:15 PM (GMT 0)
Question for you VA folks as I am somewhat confused reading some of these posts.

I thought ANY veteran of our armed forces can get free (or almost free medical tx) by going to a VA medical center.

Isn't that true?

Or is it supposed to be medical tx. only for service-connected illness/injury?

Sorry for my ignorance, but as I tell my students, the only dumb question is the one you don't ask!

Mel

Posted 12/29/2013 8:45 PM (GMT 0)
Mel,

Essentially yes. I posted a link to the VA's priority group's in another thread but I'll repeat the link here.

www.va.gov/healthbenefits/resources/priority_groups.asp

You will see that veterans in priority groups 7 or 8 can receive VA medical care, but may have to pay co-pays. Also once in the VA system the VA will treat any of a patient's medical needs, not just service-connected conditions.

Jim
Posted 12/30/2013 3:00 AM (GMT 0)

Purgatory said...


For whatever reason, my oncologist never charges me any difference to whatever Medicare is paying him.

David

Does he have much of a choice?

"Balance billing is a controversial and sometimes illegal practice that takes place when doctors and other health-care providers receive a discounted payment from the insurance company — an amount less than the fee they want to be paid. They then bill the patient for the rest. Most states have passed laws making balanced billing illegal within an insurer’s medical network. And federal law prohibits balance billing by providers paid under Medicare."
Posted 12/30/2013 3:11 AM (GMT 0)
Steven,

I really wouldn't know the answer to what you said. Honestly don't. If I were to see my PCP, which I rarely ever do, they make sure they get any co-pay or differences in service up front, or you don't get to see the doctor. My dental surgeon and dentist offices are the same way.

But with my uro and my oncologist, I have never had to make a co-pay. And at one point, I had over 50 visits with my uro alone (back in the midst of all my post surgery and stricture problems).

If I have to pay something, of course I pay like anyone else. But if they are not asking for money or sending me invoices, then that's fine, of course.

When I was under my wife's BCBS, the first 2 years of my PC journey, someone always had their hand out, and BCSC kept coming up with novel ways of charging money for this and that.

Insurance, in general, is a weak spot with me, find most of it very confusing, whether it be health related or auto or homeowners. That's why I work with good and trusted agents.

David
Posted 12/30/2013 3:23 AM (GMT 0)
This may be part of the answer I was looking for, and if any Vet is in a similar situation, found this one of the many pro-Vet advocacy sites:
----------------------------------------

Fact Sheet 16-7

June 2009




Reimbursement of Non-VA Medical Expenses for Service-Connected Veterans




Benefit Description

The Department of Veterans Affairs (VA), in limited circumstances, may provide reimbursement of non-VA medical expenses for veterans for their service-connected conditions to include those who are recently granted service-connected awards.




General Qualifying Criteria

• A medical emergency

• VA or other Federal facility not feasibly available

• Care or service was for a service-connected disability




Time Limit For Filing Claim Of Non-VA Medical Expenses:

Generally within 2 years of the date of service or notification of the allowance of a service-connected award (which may include care/services back to the effective date of award in cases of retroactive award – see example).




Retroactive Award Example

A veteran is awarded service-connected status via a Veterans Benefits Administration award letter dated January 1, 2007. The veteran filed the initial claim for service-connection on May 1, 2006. The service-connected award is retroactive to May 1, 2006.

The veteran may file a claim for private medical expenses care of the service-connected condition from May 1, 2006 forward as long as this claim is filed by January 1, 2009.




Where to File Claims

Veterans may file a claim for private medical expenses with their local VA health care facility’s Fee Basis office.




For Further Information

Contact your local VA health care facility’s Fee Basis office or VA at 1-877-222-VETS (8387). Authorities: Title 38, United States Code, §1728 and Title 38, Code of Federal Regulations, §17.120-132.
Posted 12/30/2013 3:26 AM (GMT 0)
My understanding is if they accept medicare they cannot charge you anymore than that, copays sure but thats not the same thing.

I know with my health insurance the Dr's I use accept my insurance and cannot charge me anymore on top of what the insurance pays.
I do pay copays. $20 a visit. My dental kills me as they are only a PPO and not networked like my MD's basically just a discount card, my vision plan is no bargain either.

If your PCP is charging you the difference between insurance and his normal fee, is he in your network?
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